A 68-Year-Old Man Is Seen for Follow-Up of Non-Small Cell

question 6

Multiple Choice

A 68-year-old man is seen for follow-up of non-small cell lung cancer with bone metastases.  He is accompanied by his wife, who is worried about his condition.  The patient has undergone surgical resection and several courses of combination chemotherapy.  His prognosis is 3-6 months.  At today's visit, the patient reports that his cancer pain is generally controlled, but he feels extremely weak and fatigued.  He has difficulty falling asleep and also awakens at 2:00 and 4:00 AM.  His wife says, "I make his favorite foods but he barely takes a bite.  When the children visited last weekend, he seemed uninterested in spending time with his son and grandson and retired to his room while they were still there."  The patient says, "I am just so exhausted all the time.  I know I'm not getting better and feel guilty about being a burden to my family."
The patient has lost 8.2 kg (18 lb) since his last visit.  Physical examination is otherwise unchanged.  His mood is sad but he is able to smile when appropriate.  He thinks about death and dying but has no suicidal ideation, intent, or plan.
Which of the following symptoms is most suggestive of major depression in this patient?

• A)Early-morning awakening and weight loss
• B)Guilt over burdening his family
• C)Persistent lack of energy
• D)Thoughts of death
• E)Withdrawal from family

---

Definitions:

PLC Manufacturers

Companies that design and produce Programmable Logic Controllers used in industrial control applications.

Memories

Storage areas within a computer or PLC used to hold program instructions, operational data, and other information.

Rung Condition

The current true or false state of a line of logic in ladder diagram programming.

OTE Instruction

An instruction used in programmable logic controllers (PLCs) that stands for "Output Energize," controlling the on/off status of an output based on logic conditions.